Notice of Application for a Provisional Statement

This notice is issued in accordance with regulations made under section 160 of the Gambling Act 2005

(* Required field)

Notice is hereby given that:
  2. [Give the full name of the applicant as set out in Part 2 of the application for a provisional statement]
Of the following address:

The number of whose operating licence is:
Who applied for an operating licence on:
  1. / /
Please enter details for ONE of the following:-
Insert the reference number of the applicant’s operating licence (as set out in the operating licence)
OR
Where an application for an operating licence is in the process of being made, indicate the date on which the application was made.]
  1. / /

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